In the media: Burns as a method of assault

Aim

The aims of this study were to determine whether a change occurred in the pattern of assault burn injury cases hospitalised to the adult state burns unit, Western Australia, from 2004 to mid-year of 2012, and to compare patient and burn characteristics of adult assault burns with those admitted for unintentional burns.

Methods

Study data were obtained from the Royal Perth Hospital (RPH) Burns Minimum Dataset (BMDS). Aggregated data of unintentional burn admissions during the same period were provided by the BMDS data manager to enable comparisons with assault burn patients.

Results

Assault burn admissions during 2004–2012 accounted for approximately 1% of all adult burn hospitalisations. All assault victims were burned by either thermal or scald agents. A high rate of intubation (24%) and ICU admission (1 in 3 cases) was observed in the fire assault group. The six assault cases undergoing intubation were severe burns, median TBSA 50%, most commonly affecting the face, head and torso, half of these cases had inhalational injuries and also required escharotomies.Comparison of admissions by calendar period showed no statistically significant differences in demographic, burn cause or TBSA%. However, statistically significant differences were found for pre-morbid psychiatric history (15% vs. 58%, p = 0.025) and concomitant fractures or dislocations (46% vs. 2%), p = 0.011).

Conclusions

While the proportion of assault burn admissions per total burn admissions steadily increased from 0.4% in 2009 to 1.5% in mid-2012, this proportion did not exceed that peak level observed of 2.1% for 2004.     

Incidence and treatment of burns: A twenty-year experience from a single center in Germany

Objective

To analyze trends in incidence and treatment of thermal injuries over the last two decades.

Methods

We retrospectively reviewed our local single center database of patients with thermal injuries admitted to the burn intensive care unit (BICU) of the Cologne-Merheim Medical Center (University Hospital of Witten/Herdecke). The cohort was divided into two groups according to the decade of admission and the epidemiology and clinical course of the patient sample admitted during the period 1991–2000 (n = 911) was compared to that of 2001–2010 (n = 695).

Results

The following variables were significantly different in the bivariate analysis: mean age (39.8 years vs. 44.0 years), burn size of total body surface area (23.2% vs. 18.0%) and size of 3rd degree burns (9.6% vs. 14.9%). The incidence of inhalation injury was significantly lower in the last decade (33.3% vs. 13.7%) and was associated with a shorter duration of mechanical ventilation (10.8 days vs. 8.5 days). The ABSI-score as an indicator of burn severity declined in the second period (6.3 vs. 6.0) contributing partially to the decline of BICU length of stay (19.1 days vs. 18.8 days) and to the mortality rate decrease (18.6% vs. 15.0%).

Conclusion

The severity of burn injuries during the last two decades declined, probably reflecting the success of prevention campaigns. Concerning mortality, the chance of dying for a given severity of injury has decreased.     

Management of patients in a dedicated burns intensive care unit (BICU) in a developing country

Background

In Pakistan the practice of managing extensive burns in dedicated intensive care units is not well established. This audit aims to define the characteristics of the victims of major burns and factors that increase mortality and outcome of the protocol-based management in a dedicated burns intensive care unit (BICU).

Patients and methods

This prospective audit included all patients admitted to the BICU of Suleiman Dawood Burns Unit in Karachi from 1st September 2002 to 31st August 2011. Demographic information, type and place of burn, total body surface area burn (TBSA), type of organ support provided, length of ICU stay, any associated medical diseases, and out outcome were documented.

Results

A total of 1597 patients were admitted to the BICU in 9 years. Median age of the patients was 22 (IQR = 32–7). 32% victims were children <14 years and only 7% were >50 years old. Male to female ratio was 1.4:1. Fire was the leading cause of burns in adults (64%) and scald burns were most common in (64%) in children. 72.4% of the accidents happened at home, where kitchen was the commonest location (597 cases). Mean TBSA burnt was 32.5% (SD ± 22.95%, 95%CI: 31.36–33.61). 27% patients needed ventilatory support, 4% were dialyzed and split skin graftings were performed in 20% patients. Average length of ICU stay was 10.42 days. Epilepsy, psychiatric illness and drug addiction were not common associations with burns. Overall mortality was 41.30% but it decreased over the years from 75% to 27%.

Conclusions

Groups of people most vulnerable to sustain burn are young females getting burnt in the kitchen, young males getting burnt at work, and small children falling in pots of hot water stored for drinking or bathing. TBSA >40%, age >50 years, fire burn and female gender were associated with a higher risk of death.Carefully planned, protocol based management of burn patients by burn teams of dedicated healthcare professionals, even with limited resources reduced mortality.

Recommendations

Burn hazard awareness, prevention and educational programmes targeted at the vulnerable population, i.e. women and young children at home and men at their work place is the single most cost-effective way of reducing the incidence of burns in developing countries.     

Staphylococcus aureus bacteremia after thermal injury: The clinical impact of methicillin resistance

Objective

To evaluate the impact of methicillin resistance in Staphylococcus aureus bacteremia (SAB) on mortality and length of stay in burn patients.

Design

Retrospective cohort study.

Setting

A 750-bed tertiary care university hospital in Cologne, Germany.

Patients

Patients registered in the database of the burn intensive care unit (BICU) between 1989 and 2009 with complete data sets (n = 1688).

Results

Over the 21-year study period, 74 patients with SAB were identified; 33 patients had methicillin-resistant S. aureus (MRSA) and 41 methicillin-susceptible S. aureus (MSSA). Comparing the MRSA with the MSSA population the following parameters were significantly different in the univariate analysis: BMI (27.2 kg/m² vs. 23.6 kg/m²; P = 0.05), extent of deep partial thickness burns (17.8% vs. 9.0% of total body surface area; P = 0.007), antibiotic requirement on admission (45.5% vs. 22.0%; P = 0.046), median length of hospitalization prior SAB (24 days vs. 7 days; P < 0.001), packed red blood cells administration (47.6 units vs. 26.1 units; P = 0.003), intubation requirement (100% vs. 80.5%; P = 0.007), intubation period (43.5 days vs. 26.8 days; P = 0.008), catecholamine requirement (90.9% vs. 61.0%; P = 0.004), sepsis (60.6% vs. 34.1%; P = 0.035) and organ failures (81.8% vs. 39.0%; P < 0.001). Regarding outcome parameters, methicillin resistance was not significantly related with mortality (adjusted OR 1.55, 95% CI 0.56–4.28; P = 0.40) and length of BICU stay after SAB (Kaplan–Meier analysis log-rank test P = 0.32; Cox's proportional hazards regression HR 1.22, 95% CI 0.65–2.27, P = 0.535) in the univariate and multivariate analyses.

Conclusion

Our data suggest that methicillin resistance is not associated with significant increases in mortality and length of BICU stay among burn patients with SAB.     

Mental disorders among acute burn patients

Objective

To investigate mental disorders among acute hospitalized burn patients.

Method

Consecutive acute adult burn patients (n = 107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered.

Results

The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q = 6.40, df = 1, p = 0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q = 13.00, df = 1, p < 0.001) in acute care.

Conclusions

Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium.     

Epidemiological analysis of burn patients in East Bulgaria

Objective

The purpose of the study was to identify the basic epidemiological characteristics of burn patients in East Bulgaria, as well as to analyze trends in burns in the region over the last decade.

Methods

Retrospective data of burn patients treated at Military Hospital-Varna, in the period January 2002–December 2011, was reviewed and statistically interpreted in terms of patients and burn demographics; etiology; place of incidents; hospital stay and mortality. Trends were observed for the entire period and comparative analyses of patients’ data were made between two periods: first – 2002–2006 and second 2007–2011.

Results

A total of 2627 burn patients, median age 41 years (IQR 9–61) were admitted to our burn unit. For the entire period the most affected age groups were ≤4 years (21.6%) and ≥65 years (21.1%). Hospitalized patients increased in the second period (n = 1701) compared to the first one (n = 926), while the size of total burn surface area decreased (first period – 9.8% vs. second period – 10.6%). Scald (51%) and flame (23.8%) were the most frequent aetiological agents for both periods. Work related burns reduced in the second period (9.4% vs. 4.9%), while home burns (90.6 vs. 95.1%) increased. Hospital stay declined from 17days (2002–2006) to 7days (2007–2011), whereas mortality rate slightly increased (first period – 2.3% vs. second period – 3.6%).

Conclusion

Burns remain a significant health problem in Bulgaria. The future preventive actions should take into account the observed changes in burn demographics and target the most vulnerable groups.     

Risk factors for hypotension in urgently intubated burn patients

Background

When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability.

Methods

A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality.

Results

Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n = 168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004–1.027, p < 0.001) and presumed sepsis (OR 1.852, 95% CI 1.100–3.117, p = 0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis.

Conclusions

In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors.     

A novel rapid and selective enzymatic debridement agent for burn wound management: A multi-center RCT

Objectives

Excisional debridement followed by autografting is the standard of care (SOC) for deep burns, but is associated with serious potential complications. Conservative, non-surgical and current enzymatic debridement methods are inefficiently slow. We determined whether a non-surgical option of rapid enzymatic debridement with the debriding enzyme NexoBrid™ (NXB) would reduce need for surgery while achieving similar esthetic and functional outcomes as SOC.

Methods

We conducted a multi-center, open-label, randomized, controlled clinical trial including patients aged 4-55 years with deep partial and full thickness burns covering 5-30% of their total body surface area (TBSA). Patients were randomly assigned to burn debridement with NXB (applied for 4 h) or SOC, which included surgical excisional or non-surgical debridement.

Results

NXB significantly reduced the time from injury to complete débridement (2.2 vs. 8.7 days, P < 0.0001), need for surgery (24.5% vs. 70.0%, P < 0.0001), the area of burns excised (13.1% vs. 56.7%, P < 0.0001) and the need for autografting (17.9% vs. 34.1%, P = 0.01). Scar quality and quality of life scores were similar in both study groups as were the rates of adverse events.

Conclusions

Enzymatic débridement with NXB resulted in reduced need for and extent of surgery compared with SOC while achieving comparable long-term results in patients with deep burns.

Trial registration

: Clinical Trials.gov NCT00324311.     

The increasing trend in alcohol-related burns: It's impact on a tertiary burn centre

Introduction

The incidence of alcohol-related hospital admissions is a worldwide problem and currently costs the UK National Health Service approximately 4% of its annual budget. 40% of men and 22% of women drink over the recommended UK weekly allowance. The purpose of our study was to examine the trend in alcohol-related admissions to a tertiary burns unit over a 5-year period.

Methodology

All patients admitted were documented for alcohol-related burn, and history of alcohol dependence.

Results

1293 patients admitted between 2003 and 2008 were included in the study. The number of alcohol-related burns were as follows: 2003: 6%; 2004: 10%; 2005: 16%; 2006: 9%; 2007: 19%; 2008: 19%. This increasing trend was highly significant (p < 0.0001). Alcohol-related burns had a higher incidence of flame injury (60%) and a subsequent longer length of stay (12.5 vs. 7.9, p = 0.04). Alcohol dependence was noted in 54% of all alcohol-related burns and in 5% of the non-alcohol-related burns.

Discussion

The number of alcohol-related burns admitted to a tertiary burn unit is increasing and now comprises of nearly 20% of all admissions. This highlights the growing burden of alcohol on health and the need to address it at both a national and regional level.     

Predictors of re-epithelialization in pediatric burn

Introduction

An important treatment goal for burn wounds is to promote early wound closure. This study identifies factors associated with delayed re-epithelialization following pediatric burn.

Methods

Data were collected from August 2011 to August 2012, at a pediatric tertiary burn center. A total of 106 burn wounds were analyzed from 77 participants aged 4–12 years. Percentage of wound re-epithelialization at each dressing change was calculated using Visitrak™. Mixed effect regression analysis was performed to identify the demographic factors, wound and clinical characteristics associated with delayed re-epithelialization.

Results

Burn depth determined by laser Doppler imaging, ethnicity, pain scores, total body surface area (TBSA), mechanism of injury and days taken to present to the burn center were significant predictors of delayed re-epithelialization, accounting for 69% of variance. Flame burns delayed re-epithelialization by 39% compared to all other mechanisms (p = 0.003). When initial presentation to the burn center was on day 5, burns took an average of 42% longer to re-epithelialize, compared to those who presented on day 2 post burn (p < 0.000). Re-epithelialization was delayed by 14% when pain scores were reported as 10 (on the FPS-R), compared to 4 on the first dressing change (p = 0.015) for children who did not receive specialized preparation/distraction intervention. A larger TBSA was also a predictor of delayed re-epithelialization (p = 0.030). Darker skin complexion re-epithelialized 25% faster than lighter skin complexion (p = 0.001).

Conclusions

Burn depth, mechanism of injury and TBSA are always considered when developing the treatment and surgical management plan for patients with burns. This study identifies other factors influencing re-epithelialization, which can be controlled by the treating team, such as effective pain management and rapid referral to a specialized burn center, to achieve optimal outcomes.     

Acute burn induced coagulopathy

Background

Acute traumatic coagulopathy is well described in the trauma population. Major burns are characterised by a similar endothelial injury and cellular hypoperfusion. These features could be a driver for an acute burn induced coagulopathy (ABIC).

Methods

Patients admitted to a regional burn centre over a 71 months period with a total body surface area burn of 30% or more were identified. The metavision electronic patient database was scrutinised for a predetermined list of demographics, interventions and admission investigations to identify any clinically significant ABIC.

Results

On admission 39.3% of the 117 patients analysed met our criteria for a coagulopathy. Of the patients with a coagulopathy, 71.7% had an elevated Prothrombin Time (PT), 2.2% had an elevated Activated Partial Thromboplastin time (APPT) and 26.1% had an elevation of both. Patients with a coagulopathy received a similar volume of fluid (p = 0.08). There was a statistically significant correlation between the PT and the abbreviated burn severity index (p = 0.0013, r = 0.292) and serum lactate (p = 0.0013, r = 0.292). ABIC was an independent predictor of 28 day mortality, OR 3.42(1.11–10.56).

Conclusion

In patients with major thermal injuries a clinically significant ABIC exists. Early diagnosis and treatment of ABIC should be considered particularly in those undergoing total burn wound excision.     

Outpatient burn data: An untapped resource

Introduction

The National Burn Repository (NBR) currently only contains inpatient data from participating United States burn centres. However, the majority of the patients treated in burn centres are managed as outpatients. Unfortunately, this significant demographic is not represented in the NBR annual report. The purpose of this study is to compare the difference in aetiology and demographics between inpatient and outpatient burn patients. In addition, the workload demands for data entry of inpatient and outpatient records in the burn registry will be compared.

Methods

Outpatient and inpatient burn data at an American Burn Association-Verified Burn Center were prospectively collected during fiscal year 2008. Data collected included age, burn size and aetiology of burn. Aetiology was also stratified by age group. Inpatient data were compared with outpatient data with Fisher's exact test. The amount of time taken to enter inpatients’ and outpatients’ data parameters in the TRACS v5.0 database was also recorded.

Results

Data were collected for 241 inpatients and for 543 outpatients during fiscal year 2008. No significant differences in gender or race were found between the two groups. When comparing demographics, outpatients tended to be younger (26 ± 19 years vs. 32 ± 22 years, p = 0.01) with a smaller burn size (2.5 ± 7% vs. 6.8 ± 12%, p < 0.001) and a lower frequency of full-thickness burns (17% vs. 41%, p < 0.001).Of the patients managed as an outpatient, a total 29.7% were eventually admitted to the hospital. Just over half of those (16.7%) initially managed in the outpatient setting were admitted for a planned surgical procedure. The other 13% were admitted for pain control and wound-care issues.Injury was more likely to be caused by flame in inpatients (p < 0.001). Scald injuries were more common in the outpatient setting (34% vs. 27%), but this difference did not reach statistical significance (p = 0.079). Outpatients were more likely to be injured with a contact burn (p < 0.0001). Outpatient injury was more likely to be work-related than inpatient injury (p = 0.0497), but less likely to be related to recreational activity (p = 0.006) or arson/abuse/assault (p = 0.0158). An experienced TRACSv5.0 user required 11 ± 0.6 min to enter an inpatient record and 6 ± 0.6 min to enter an outpatient record in the system (p = 0.002).

Conclusions

Inpatient injury is more likely to be caused by flame, whereas outpatient injury is more likely to be caused by scald and contact burns. Work-related burn is more likely to be treated in the outpatient setting. Outpatient burn data also take less time to enter. Since significant differences in aetiology exist, outpatient data should be reported separately from inpatient data in order to understand the full spectrum of burn aetiology. The NBR and other registries should be modified to track outpatient burn data and outcomes.     

Epidemiology of hospitalized burn patients in a tertiary care hospital in South India

Background

The epidemiological pattern of burns varies widely in different parts of the world. To suggest effective preventive measures, an insight into the pattern of injury is desirable. However, data on burn victims and outcome is limited from this part of the world.

Methods

This study was conducted in the Department of Surgery, from April 2006 to April 2007. All consecutive patients with major burns admitted for in-hospital treatment during the study period were included in the study. The data collected included age, gender, cause and mode of burns, presence or absence of inhalational injury, facial burns, time delay from burn injury to admission in the hospital, burns depth, total body surface area distribution of burns, associated injuries and co-morbid illness, microbiological profile and outcome. Inhalational injury was assessed by clinical examination as bronchoscopy was not available.

Results

A total of 222 consecutive patients admitted for in-hospital treatment of burn injury were included in the study. 177 patients were adults and 45 were <13 years of age. The female:male ratio was 1.7:1. In adults, 52.5% of burns were due to non-intentional injury and 43.9% were due to self-immolation. In patients <13 years of age, 95.6% of cases were due to non-intentional injury. The mean TBSA was 48.75% and 30.18% of patients had predominantly deep burns. The overall mortality was 60.8%. The predominant organisms colonizing the burn wound were Pseudomonas aeruginosa (81.1%) followed by Acinetobacter species and MRSA. Multivariate logistic regression analysis of factors predicting survival in patients with burn injury showed that TBSA > 30%, age > 20 years, female gender and presence of facial injury were statistically significant as predictors of risk of death.

Conclusions

In patients with burns, total body surface area involvement more than 30%, age more than 20 years, female gender and presence of facial injury are statistically significant, as predictors of poor outcome and risk of death. The strongest association was seen with facial injury, which increased the risk of death by fourfold.     

Stroke after burn: Population data analysis

Purpose of the study

We aimed to describe a population cohort study of burns with the prevalence of stroke, and discuss possible etiologies.

Analytical methods

This study uses data obtained from the Longitudinal Health Insurance Database 2005 (LHID2005). The study cohort consisted of all patients who had diagnoses of burn recorded in the database (ICD-9-CM codes 948) between January 1 2004 and December 31 2008 (N = 1549).

Main findings

The patients with burn and the comparison cohort are 7410 patients, 146 experienced stroke during the follow-up period of up to 5 years. In average, the burn patients suffered from stroke by 1.48 years after burn. The hazard ratio of stroke was 1.74 (95% CI, 1.15–2.63) for patients with TBSA burn <20%, 3.78 (95% CI, 1.39–10.26) for patients with TBSA burn ≥20%. The adjusted hazard ratio of ischemic stroke was 1.63 for patients with TBSA burn <20%, 2.96 for patients with TBSA burn ≥20%, whereas the hazard ratio of hemorrhagic stroke were not significant (p = 0.231).

Conclusions

In our study, severe burned patients, more than 60 years of age, had higher risk of stroke in their recovery life. We suggest close follow up for the burn patients in high risk of stroke.     

Outcomes after cardiac arrest in an adult burn center

Objective

Adult burn patients who experience in-hospital cardiac arrest (CA) and undergo cardiopulmonary resuscitation (CPR) represent a unique patient population. We believe that they tend to be younger and have the added burden of the burn injury compared to other populations. Our objective was to determine the incidence, causes and outcomes following cardiac arrest (CA) and cardio-pulmonary resuscitation (CPR) within this population.

Methods

We conducted a retrospective review at the US Army Institute of Surgical Research (ISR) burn intensive care unit (BICU). Charts from 1st January 2000 through 31st August 2009 were reviewed for study. Data were collected all on adult burn patients who experienced in-hospital CA and CPR either in the BICU or associated burn operating room. Patients undergoing CPR elsewhere in our burn unit were excluded because we could not validate the time of CA since they are not routinely monitored with real-time rhythm strips. The study population included civilian burn patients from the local catchment area and burn casualties from the conflicts in Iraq and Afghanistan, but patients with do-not-resuscitate (DNR) orders were excluded.

Results

We found 57 burn patients who had in-hospital CA and CPR yielding an incidence of one or more in-hospital CA of 34 per 1000 admissions (0.34%). Fourteen of these patients (25%) survived to discharge while 43 (75%) died. The most common initial cardiac rhythm was pulseless electrical activity (50.9%). The most common etiology of CA among burn patients was respiratory failure (49.1%). The most significant variable affecting survival to discharge was duration of CPR (P < 0.01) with no patient surviving more than 7 min of CPR.

Conclusions

CPR in burn patients is sometimes effective, and those patients who survive are likely to have good neurological outcomes. However, prolonged CPR times are unlikely to result in return of spontaneous circulation and may be considered futile. Further, those who experience multiple CA are unlikely to survive to discharge.     

Serum phosphate level in burn patients

Introduction

Despite plasma phosphate imbalance being rare, it is a relatively common finding in certain subsets of burn patients. It may occur due to the burn itself or as a result of the treatment. Severe hypophosphataemia (<1.0 mg dl⁻¹) is associated with a significant morbidity and a fourfold increase in mortality. In this study, the relation between serum phosphate level and the total body surface area (TBSA) of the burn was compared.

Methods

According to the percentage of TBSA of the burn, the patients (n = 155) were divided into three groups: group A with 20–29% TBSA burns, group B with 30–39% and group C with more than 40% TBSA burns (62, 48 and 45 patients, respectively).Analysis of variance (ANOVA)-repeated measure was used to detect any statistically significant difference in the three post-burn time-points of 3rd, 6th and 9th days and the mean score of the serum phosphate level between the three groups.

Results

The incidence of hypophosphataemia at 9th post-burn day in the three groups was 6.1%, 32.4% and 73.5%, respectively. There were significant differences (p < 0.05) between mean serum phosphate levels of groups A and C, B and C and A and B as well. We found significant differences between the three post-burn follow-up time stages.

Discussion

We have shown that hypophosphataemia, defined as mean serum phosphate levels below 3.0 mg dl⁻¹, was very common following burn, based on 75.6% of patients with more than 40% burn at the 3rd post-burn day. As the percentage of TBSA of burn increases, the incidence of hypophosphataemia significantly increases. We suggest that phosphate level be routinely measured after a major burn, especially in patients with a complicated course, so that appropriate replacement therapy may be started in a timely manner.     

Determinants of burn first aid knowledge: Cross-sectional study

Introduction

This study investigated demographic factors, experience of burn/care and first aid course attendance as factors influencing burn first aid knowledge.

Methods

A cross-sectional study was undertaken using convenience sampling of members of sporting and recreation clubs. The main outcome measure was the proportion of correct responses to multiple-choice questions relating to four burn scenarios: (1) scald, (2) contact burn, (3) ignited clothing, and (4) chemical burn.

Results

A total of 2602 responses were obtained. Large gaps (30–50% incorrect answers) were identified in burn first aid knowledge across all scenarios. 15% more individuals gave correct answers if they had attended a first aid course compared to those who had not (p < 0.0001); this proportion increased if the course was undertaken within the previous five years (p < 0.0001) or contained a burns-specific component (p < 0.0001). Males and younger (≤25 years) and older (≥65 years) age-groups had relatively lower levels of burn first aid knowledge. Gender and age were significant predictors of first aid course attendance, with males and younger (≤25 years) and older (≥65 years) age-groups less likely to have attended a first aid course.

Conclusion

In this sample, first aid training undertaken within the last 5 years with a specific burns component was associated with enhanced burn first aid knowledge.     

Acalculous cholecystitis in severely burned patients: incidence and predisposing factors

Objective

To investigate the incidence and predisposing factors of acalculous cholecystitis (AAC) in severely burned patients.

Background data

Although some studies report on AAC in critically ill patients, very little is known about AAC after severe burns.

Methods

We conducted a retrospective cohort study involving patients with burns admitted to the burn intensive care unit (BICU) of a university hospital. The patient cohort was divided into two groups (AAC group: burned patients with histological proven acalculous cholecystitis, n = 15; Control group: population of all other burned patients admitted to the BICU, n = 1225). Univariate and multivariate analyses were used to identify predisposing factors for the development of AAC.

Results

Fifteen patients with acalculous cholecystitis were identified in the study period. This represents 1.2% of all significant burns admitted. Comparing the AAC group with the Control population the following patients’ characteristics, therapeutic measures and outcome parameters were significantly different in the univariate analysis: mean age (54.0 years vs. 42.0 years), BMI (28.9 kg/m² vs. 25.6 kg/m²), abbreviated burn severity index (8.3 vs. 6.4), total body surface area burn deep partial thickness (12.0% vs. 6.2%) and full thickness (10.2% vs. 6.8%), concomitant inhalation injury (80.0% vs. 28.9%), sepsis (46.7% vs. 14.9%), catecholamine (100% vs. 30.4%) and antibiotic requirement (100% vs. 58.2%), non-biliary tract operations (4.9 vs. 1.5), BICU length of stay (63.4 days vs. 21.0 days), ventilator days (50.3 vs. 11.9), packed red blood cells (PRBCs) administration (70.0 units vs.13.0 units) and mortality (53.3% vs. 19.7%). In the multivariate analysis however, only age, the number of administered units of PRBCs and the duration of mechanical ventilation turned out to be independent predictors for the occurrence of AAC.

Conclusion

AAC is a rare complication of severely burned patients and may reflect the severity of the patient’s general conditions. Predisposing factors for AAC are advanced age, the need of blood transfusions and prolonged mechanical ventilation. In the presence of these predisposing factors, early monitoring may help to detect AAC earlier and to initiate appropriate intervention.